India’s Menopause Moment: Experts Break the Silence Around Women’s Health After 45

Instead of bottling her anxieties, Kapoor began hosting town-hall conversations at work, urging women — and men — to speak openly about what remains cloaked in silence and embarrassment. Menopause, when a woman stops having periods and is out of her reproductive cycle, is the most challenging time in a woman’s lifetime. Female hormones dip, changing their metabolism, thinking, functioning and identity. Worse, they become most risk-prone to stubborn diseases, be it diabetes, heart disease, obesity and osteoporosis. Worst, it impacts their desire, the currency that changes the way men see them. This transitional phase determines what a woman will be or can be in the next 30 years of her life.

“Women’s health discussions are always around their reproductive arc, be it anaemia, pregnancy and adolescent health. But after 45, given the tilting of India’s demographic profile towards mid-life, increased life expectancy and the rising financial independence of women, we need to talk about menopause with all seriousness. Women should not feel guilty about reclaiming their desire back even in their late 50s. It is not vanity,” says Dr Meenakshi Ahuja, an executive member of the Indian Menopause Society and senior director of Obstetrics and Gynaecology at Fortis Le Femme, Delhi. Menopause has also been quickly assigned to ageism, seen as a loss of femininity, youth and purpose, which leads to feelings of shame and reduced self-esteem. But with the Indian Menopause Society estimating that 140 million Indian women are expected to be in or past menopause by 2026, the silence around it would complicate health and social challenges. A 2022 survey by Abbott showed that 79 per cent of Indian women are not comfortable discussing menopause with family or colleagues. That’s why Kapoor has started encouraging open space interactions in the workplace. “If women are not accepting and aware of their condition, how else would they expect men, in fact, anybody else to be co-travellers in their journey?” she adds.

For her sessions, she tied up with menopause advocate Shaili Chopra and founder of Gytree, India’s first menopause stack, which offers doctor-verified AI tools, expert consultations, diagnostics and nutraceutical support. “Conversations can move the needle. A senior executive approached us for guidance and supplements for both his wife and house help,” says Kapoor. Inside her own home, shared conversations have meant her husband and son have become sensitive to her needs whenever she has mood swings or heavy bleeding. “My husband ensures I keep follow-up appointments with my doctor. My 17-year-old son helps me around and tells my husband, ‘Unhe tang mat karo (Don’t irritate her),” adds Kapoor.

Leading conversations

Chopra launched her platform because she wanted answers about her own body. “Women are hungry for information. The 40s can be their worst decade. Besides, 90 per cent of menopause-related information is based on Western women. Indian women are becoming menopausal earlier, between 38 and 45, and we are not even prepared. There’s good news with pregnancy and bad news with cancer. Nothing in between. We can’t whine over wine anymore,” she says.

Actor and menopause educator Lisa Ray has also transformed social media into an open, engaging space for conversation. Diagnosed with multiple myeloma in 2009, which led to a chemotherapy-induced menopause at 37, she is now preparing to launch her own community platform. “Menopause is like second puberty when you become a stranger in your own body,” she says. “Our mothers and aunts were conditioned to gulp and digest these changes. They couldn’t guide us. The neighbourhood doctor doesn’t help much. Some are judgmental, dismissive and gaslight women, saying it is part of ageing. They offer no options for relief even when they exist. What women need are endocrinologists who understand the business of hormones. Menopause is not a checklist of diseases,” she argues.

Ray speaks of symptoms often ignored — sudden fatigue, dizzy spells, itchy ears, burning scalp, frequent urinary tract infections, hair falling out in clumps. “Research into women’s health remains tragically underfunded and women were not routinely included in clinical trials until 1991. What nobody tells you is that symptoms indicate menopause has already manifested. You should prepare 10 years before, during perimenopause. Begin with getting your hormones tested,” says Ray, who prioritises fitness and diet so she can run on the beach with her twin daughters, born through surrogacy, at 50.

Chopra is expanding the conversation beyond urban India. Maharashtra has already set up menopause clinics in government hospitals and Kerala is establishing them at district hospitals. Ground reports indicate that women are curious but have very low awareness. “In the villages, there is so much trauma associated with periods: no entering the kitchen, no bathing, solitary confinement. So, women are happy that menopause signals the end of their socio-cultural curfew. They do not understand the health impacts that may deplete their strength further,” says Chopra.

Ray gives practical tips asking designers to put out body-friendly lines for the post-40 woman and does reels on wisdom bytes. “Women become their true selves. People-pleasing goes away as the nurturing hormone estrogen goes down. Lifting weights, having protein and minerals are non-negotiable. Culturally, we are told that a brain’s functions decline. But Hormone Replacement Therapy (HRT) can help menopausal women improve brain function by reducing brain fog, enhancing memory, improving focus and stabilising mood swings,” says Ray.

She met a woman who told her that her family convinced her that HRT was about vanity and preserving beauty. Another woman told her how a male gynaecologist withdrew the HRT advisory for her because her husband felt it would amp up her sex drive. “HRT is connected with the endocrine system and can help women power through,” she says, dispelling the myth. Dr Ahuja, too, concurs saying HRT is now considered safe for most women under 60 or within 10 years of menopause.

Man-woman relationship

Awareness may be inching forward but male engagement lags. Both Dr Ahuja and Dr Ruma Satwik, fertility specialist at Sir Ganga Ram Hospital, New Delhi, rarely see men accompanying partners to consultations. While social media-driven conversations have encouraged women to get their health check-ups done early, perhaps a clinic is not the best setting. “Menopause is about multidisciplinary care, with a dietician, physiotherapist, psychiatrist, endocrinologist and a cardiologist. So an approachable wellness centre that shifts the focus to quality of life and good living can ease concerns of both partners,” says Dr Satwik.

Chopra recounts an elderly woman describing how her husband walked away to the bar during a restaurant conversation about menopause with her daughter. “It is because of this gap in understanding what a woman needs, why she might become less tolerant or irritable or sink into depression that male complacence is challenged. And that leads to conflicts. Do you realise that divorce rates go up among women over 45?” asks Chopra, who talks to men celebrity crusaders on menopause but admits that is hardly representative of the prevailing male mindset.

This is what prompted Maansi Gupte, 37, to make a short film in 2019 called Painful Pride, featuring Rituraj Singh and Pallavi Joshi, about the need for family acceptance of menopause and extending support to the woman protagonist, so that she feels relevant to herself first, then others. “I referenced a friend’s sister-in-law, whose family suspected she had a personality disorder. Most women don’t talk about it because they are worried how other people would perceive them. In fact, Pallaviji herself was battling itchiness and sleep issues during the shoot,” says Gupte, who entrusted the script and direction to men. They admitted that making the film helped them understand their mothers and aunts better and why men needed to be nurturers for a change. “I wanted that empathy and wanted it to speak to men watching it,” she adds.

While films nudge the cultural mindspace, mainstream films have reduced mature women to idolatory at best, a victim in between and a fallen cougar at worst. Menopause has largely been a taboo subject, a fact challenged by filmmakers like Alankrita Shrivastava. Her OTT series Bombay Begums has the protagonist Rani dealing with the onset of menopause, as a normal, albeit challenging, part of her life, rather than a hidden shame. As Shrivastava had said then, characters dealing with menopause are not defined by their loss of fertility but rather by their reclaiming of power despite it.

Medical breakthroughs

That power comes from new research and easier, low-dose HRT gel formulations that carry fewer risks of blood clots or breast cancer. “The fears around HRT stemmed from flawed studies done with women in their 60s and 70s, who were anyway at risk of stroke, obesity and diabetes. Re-analysis of data confirms it is most effective for protecting bone density and prevents, rather than causes, plaque buildup in the heart, when started early,” says Dr Ahuja.

Besides, there are clear guidelines on usage. HRT is required for many Indian women as one in 100 goes through premature ovarian insufficiency and early menopause. “This affects their heart and urogenital health, lipid and sugar metabolism. I tell people everywhere, we are just replacing hormone loss with the same hormones. For 25 years of faulty research, women have been deprived of their right to access menopausal relief. They deserve it,” argues Dr Ahuja.
Helping women understand their hormones better is what Stanford graduates Abhinav Agarwal and Jenny Duan are doing through their startup Clair, a wearable hormone tracker for women, offering continuous, non-invasive monitoring. It uses AI and 10 bio-sensors to track 130 biomarkers in real-time. The device can pick up heat signals. So, when the hormone progesterone is high, it will raise the body temperature. When estrogen is low, which tricks the body into thinking the body is warm as in a hot flash, it can send the information to an app. “The wearer knows what to expect. Doctors know what dose of HRT to give. This is a huge help as only 20 per cent of gynaecologists are trained in menopause,” says Agarwal.

The tracker even measures water accumulation during menopause. It gives the woman an idea about when they might get symptoms like migraine. “Ovaries fail by the time women get hot flashes. We want to unlock the secrets before,” says Agarwal, whose device is up for approval by the US FDA and claims a 94 per cent accuracy.

Corporate duel

The toughest challenge is dealing with the mental health fallout and women’s failure to admit to it, particularly in the workplace. Most senior executives feel vulnerable about their emotional imbalance. Unable to express themselves for fear of being overlooked for promotions or projects, they endure it silently. “The pressure to deal with physical requirements during menopause is unrecognised. And that’s a stressor,” says Chopra.

In fact, she did a survey which showed that 85 per cent of women felt menopause conversations at work were either insufficient or completely non-existent, with over 50 per cent reporting productivity challenges due to menopause-related symptoms. Altogether, 71 per cent of women did not feel supported in their menopause journey, often feeling judged for their mental health and changing bodies. But what stunned Chopra was that over 50 per cent of women had never consulted a gynaecologist about their menopause symptoms, some even settling for herbal concoctions like ajwain water.

From vaginal gels, supplements and vitamins, to body-shapers, leak-proof underwear for incontinence and relaxants, the menopause product market in India is growing rapidly and is expected to reach $1.67 billion by 2030. The paying woman professional makes for a good market but what does she truly need? Several companies in India such as HSBC, IBM, HUL and Cognizant are introducing menopause-friendly policies, be it flexible work options, leaves, facilitating access to doctors and increasing medical packages to cover menopause-related complications.

However, enabling policies such as leaves will always seem like tokenism and charity and build more walls against women. “We are talking about decades together, about a third of a woman’s life. That requires women to verbalise the changes inside them, men to recognise and understand them. That way women may even understand andropause in their partners. There’s no woman thing, man thing or age thing. There’s only reimagining life,” says Ray.